TN methadone clinics could get new rules
3:22 AM, Jan. 28, 2012**|** Comments
Tom Wilemon | The Tennessean
News Health & Medicine
A state agency has proposed new rules aimed at getting more addicts out of methadone clinics and into programs that wean them completely off drugs.
Some of those rules may have unintended consequences, say the people who run the clinics. Smoking marijuana could get a heroin addict kicked out of treatment, leaving that person desperate for a fix, said Dr. Ana Sarasti, a psychiatrist with Behavioral Health Group, which operates seven methadone clinics in Tennessee.
“They are going to have to do something to deal with their addiction,” she said. “Most of the time, that is something that is not on the legal end of the spectrum.”
Outpatient clinics have used methadone for decades to help addicts maintain normal lives. The Department of Mental Health wants to revise the rules because more Tennesseans than ever are on methadone treatment, rising from 1,600 to more than 6,000 in the past seven years because of addictions to painkillers, said Rodney Bragg, an assistant commissioner.
“The practice is that people are put on maintenance drugs,” Bragg said. “We would like to see people be detoxed and be able to live a drug-free life. We do see that there is a place for the methadone clinic, absolutely a place. It is responsible treatment for some folks, but we also feel that people need to be able to function fully in their life by not being on a narcotic.”
The painkillers in the bathroom cabinet, such as OxyContin, drive most of Tennessee’s addictions. People who have tried and failed to quit opioids turn to methadone, a drug that prevents withdrawal symptoms and allows them to function.
How long a patient stays on methadone treatment can vary greatly, depending upon the degree of addiction and the drug. In most cases, people have to pay out of pocket for the treatments. TennCare does not reimburse; nor do many private insurers.
Clinics raise objections
Doug Varney, the new head of the Department of Mental Health, is pushing for methadone clinics to do a better job of weaning people off the maintenance drugs and into detoxification programs. The 12 methadone clinics in the state are all privately run but regulated by the state.
But the people who run the clinics object to some of the proposed rules, such as edicts to discharge patients who fail drug screens and limitations on when patients can start methadone treatment.
“I can tell you stories of people who came in and 18 months later they made dramatic recoveries, and scaling them down for discharge was appropriate,” said Andrew Love, chief executive officer of Behavioral Health Group. “I can tell you about people who are in the program for 12 years. In that 12th year, they made remarkable advancement and eventually got off the program and lived a wonderful life.”
Love said the new regulations are a mix of the “good, bad and ugly.” The rules don’t make sense in regard to marijuana screenings, he said, because as they are currently written, someone could get kicked out of treatment before evidence of the drug has time to exit the body.
Bragg said the state agency is considering tweaking that rule after clinicians pointed out the unintended consequence. A public meeting was held this month on the proposed changes, which could take effect by year’s end.
Love said other changes are needed. He criticized one rule that would require two years of serious opioid addiction before a patient can start methadone.
“We are telling people, ‘You have to demonstrate this kind of strange commitment to your addiction for another year before you are worthy of treatment,’ ” Love said. “It’s like telling a heart patient, ‘Your arteries aren’t clogged up enough. We really need to do the operation, but I need you to go eat a stick of butter each day.’ ”
Another proposed rule requires the blessing of a city or county government before the state will permit a new clinic to open.